Provider Demographics
NPI:1992549307
Name:THORNTON, JILLIAN (MA LPC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 TROON ST
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-4344
Mailing Address - Country:US
Mailing Address - Phone:708-882-2830
Mailing Address - Fax:
Practice Address - Street 1:755 ALMAR PKWY
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2392
Practice Address - Country:US
Practice Address - Phone:815-214-9079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.020206101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health